Third of Iraq Vets Seek Mental Health Services

Study found most did so within two years of return

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"We were pleasantly surprised at how many folks were seeking mental health, and so many of them seeking mental health in the first couple of months," said Dr. Charles S. Milliken, a psychiatrist at Walter Reed Army Institute of Research.

Milliken is senior author of a study appearing in the March 1 issue of the Journal of the American Medical Association.

Operation Iraqi Freedom (OIF) was launched in March 2003, and has become the largest sustained ground operation since the Vietnam War.

The U.S. military has several programs in place to screen war veterans as they return stateside.

One Army program gives veterans a half-day schedule so they can reconnect with their families for part of each day and, for the other part, stay with their soldier buddies.

"It's not like they go cold turkey," Milliken explained. "It gives the family a chance to get used to the soldier and the soldier a chance to get used to them but, at the same time, they're staying in touch with their comrades." Soldiers also receive instruction and guidance on adaptation responses, such as hypervigilance and sleep.

The other program, the Post-Deployment Health Assessment, screens all returning servicemen and women for physical and mental health problems.

The current analysis is the first of data from the Post-Deployment Health Assessment, which, in turn, is one of the first databases of its kind.

"This is new work," Milliken said. "In previous wars, the incidence of the mental health impact of war and the trauma of war really wasn't studied until usually three to four years after the conflict was over."

"They have some compelling data on the potential volume of people who are going to come here and potentially be in need of some assistance from the medical system," added Simon Rego, associate director of psychology training at Montefiore Medical Center and an assistant professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, both in New York City. "Because of advancements in electronic data management, this is one of the first times they have been able to look prospectively at this issue."

The database included information on 16,318 personnel returning from Afghanistan, 222,620 returning from Iraq, and 64,967 who had served elsewhere. The assessments, which screened for PTSD, major depression and other mental health problems, were completed between May 1, 2003 and April 30, 2004.

Individuals returning from Iraq experienced more combat and more mental health problems than individuals returning from Afghanistan or other locations. Slightly more than 19 percent of soldiers and Marines coming back from Iraq met the risk criteria for a mental health concern, vs. 11.3 percent for Afghanistan and 8.5 percent for the remainder.

People who had been exposed to fighting in Iraq were more likely to screen positive for post-traumatic stress disorder (PTSD). Close to 80 percent of service members who screened positive for PTSD after returning from Iraq reported having seen a person wounded or killed or having discharged their weapon in direct combat, compared with 47.8 percent of those who screened negative for PTSD.

Thirty-one percent of Iraq veterans had at least one outpatient mental health care during the first year after deployment. Thirty-five percent of Iraq veterans used mental health services annually, including 12 percent who used services for a mental health problem.

More than half (56 percent) of those who were referred to mental health services actually received follow-up care.

"There seems to be a discrepancy between the numbers referred for help and those seeking help," Rego said. "There's clearly something they should be doing to increase the screening process."

Less than 10 percent of all service members who received mental health treatment were referred through the screening program.

Mental health problems were also associated with attrition from the military.

Overall, however, the services view the news as positive.

"The military is really trying to be proactive about mitigating the kinds of mental health impacts that we see with war," Milliken said. "The real good news was that a lot of folks are touching mental health services in that first year, that in itself is a concern because, with young males, stigma can be an issue."

"Even better news is that two-thirds of those are doing it in the first two months back," he continued. "We want folks to get help early on so the symptoms don't go on to become chronic PTSD or other chronic problems."

The analysis should also serve as a guide as the military calculates what future mental health resources its service members will need.